Medical imaging is a critical and expensive component of health care with a cost of $100 billion or $350 per person per year. Health information technology (HIT) is proposed as a means to reduce costs and improve health through more efficient and coordinated services. The gains will be greatest in communities with unmet health needs;however, these communities present unique HIT challenges. We propose a demonstration project of clinical imaging data sharing in the rural and urban southeastern U.S. Personal health record (PHR) approaches are promising as an effective framework for sharing medical information;however, imaging poses unique challenges. Existing approaches include a centralized repository, which if expanded to medical imaging would require substantial archive and network infrastructure. These resources do not currently exist in most communities, especially rural and underserved communities, presenting logistical and financial barriers. We propose a new approach that we have named "Personally Controlled Access key REgistry" or PCARE. PCARE addresses the fundamental problem of moving large amounts of imaging data from imaging providers to a centralized archive. In the PCARE paradigm the imaging data remains at the performing imaging provider as the primary archive until needed by an authorized health care provider. In place of the PHR archive, the PCARE is a central repository of secure encrypted electronic "keys". These electronic "keys" are under the direct control of the patient or authorized representative. The patient can grant and revoke access to providers to their data irrespective of the physical location of the patient, images or provider. The transfer of the imaging data from the performing facility directly to any provider of the patient's choosing can occur in a selective and timely manner. This innovation takes full advantage of the patient controlled nature of the PHR paradigm and overcomes many of the pitfalls of a centralized health record approach in regards to imaging. The broad, long-term objective is to improve health care through improved sharing of medical imaging data. Effective sharing can improve diagnosis, reduce unnecessary testing and contain costs. The specific aims are: (1) to analyze the needs, capabilities, and obstacles for medical image sharing across the spectrum of patients, providers, and medical facilities in rural and urban Southeastern U.S. as a national model for underserved communities. (2) to develop a patient controlled platform for medical image sharing using PCARE, designed to integrate seamlessly with electronic health records of participating providers. (3) to deploy a prototype PCARE system for image sharing in diverse types of facilities located in rural and urban communities to demonstrate the feasibility and measure the acceptance of patients, providers and other stakeholders. The concept could be easily expanded to additional components of the electronic health record. PUBLIC HEALTH RELEVANCE: Medical imaging is a major health care cost and current strategies to share image data between providers are inadequate and cause higher costs and negative health consequences to patients. We will develop and test a novel approach for sharing medical image data using a Personal Health Record (PHR) approach in rural and urban southeastern U.S., a diverse region with established unmet health care needs.